The Article in Brief

Reconceptualizing the Experience of Surrogate Decision Making: Reports vs Genuine Decisions

Laurence B. McCullough , and colleagues

Background When patients are no longer able to make decisions about their life-sustaining treatment, family members or legal representatives must serve as surrogate decision makers. Their decisions are based on substituted judgment (the patient's values and preferences) or, if such values aren't known, they are based on what is in the patient's best interest. In this article, the authors reexamine this decision-making model to better reflect the experience of making surrogate decisions.

What This Study Found The authors propose that the current model of surrogate decision making be replaced by a new model. The new model distinguishes between making decisions for the patient, which is necessary when patient preferences are not known, and making reports on the patient's behalf when preferences are known. Making reports carries less stress and anguish than actual surrogate decision making.

Implications

• The concept of surrogate decision making should be used only when actual decision making is needed. Clinicians should help patients distinguish between making reports and making decisions.